# Cognitive function and social cognition in adolescents with bipolar disorder: comparison between manic episode and remission period

## TL;DR

This study compares cognitive and social cognitive abilities in adolescents with bipolar disorder during manic episodes and remission, finding more impairments during manic phases.

## Contribution

The study provides new insights into cognitive and social cognitive differences in early-onset bipolar disorder across manic and remission states.

## Key findings

- Impairments in processing speed, inhibition, and attention were more severe during manic episodes compared to remission.
- Patients in remission showed significant deficits in verbal and visual memory, working memory, and theory of mind compared to healthy controls.
- Cognitive impairments persisted even during remission, suggesting a need for targeted interventions.

## Abstract

We aimed to investigate the extent of cognitive impairments in early-onset bipolar disorder (EBD) during manic episode in comparison to remission period.

30 healthy controls (HC) and 95 patients with EBD, with manic episode (n = 55) and remission period (n = 40) were included. Additionally, 31 (%56.4) of 55 patients with manic episode were re-evaluated during remission. A comprehensive cognitive battery was implemented to asses verbal and visual learning/memory, attention, inhibition, problem-solving, working memory, processing speed, and verbal fluency skills and global cognitive factor was calculated to estimate overall cognitive ability. Theory of mind (ToM) was evaluated using the Reading the Mind in the Eyes and Faux-Pas tests.

Individuals in patient groups and HC were matched for gender and education. Patients in remission had a significantly older mean age than the other groups. Antipsychotic dosage was also higher in cases with mania. Patients with manic episode had moderate impairments in processing speed (Cohen’s d: 0.51–0.78), attention (d: 0.57), inhibition (d: 0.56–0.63) and global cognitive function (d: 0.54) compared to patients in remission period. Individuals in remission period had poorer performance in verbal memory (d: 1.03–1.32), working memory (d: 0.88–1.13), ToM (d: 0.60–0.87), processing speed (d: 1.21–1.27), problem solving (d: 0.56–0.67), attention (d: 0.58), inhibition (d: 0.89-1.00) and visual memory (d: 1.28–1.37) in comparison with HC.

Our findings indicated that impairments in social cognition, processing speed, inhibition, and attention were more prominent in the manic episode. Future studies should focus on pharmaco- and psychotherapeutic interventions aimed to treat neurocognitive impairments.

The online version contains supplementary material available at 10.1007/s00406-025-01987-0.